Abstract
PurposeTo test the effect of anatomic variants of the prostatic apex overlapping the membranous urethra (Lee type classification), as well as median urethral sphincter length (USL) in preoperative multiparametric magnetic resonance imaging (mpMRI) on the very early continence in open (ORP) and robotic-assisted radical prostatectomy (RARP) patients.MethodsIn 128 consecutive patients (01/2018–12/2019), USL and the prostatic apex classified according to Lee types A–D in mpMRI prior to ORP or RARP were retrospectively analyzed. Uni- and multivariable logistic regression models were used to identify anatomic characteristics for very early continence rates, defined as urine loss of ≤ 1 g in the PAD-test.ResultsOf 128 patients with mpMRI prior to surgery, 76 (59.4%) underwent RARP vs. 52 (40.6%) ORP. In total, median USL was 15, 15 and 10 mm in the sagittal, coronal and axial dimensions. After stratification according to very early continence in the PAD-test (≤ 1 g vs. > 1 g), continent patients had significantly more frequently Lee type D (71.4 vs. 54.4%) and C (14.3 vs. 7.6%, p = 0.03). In multivariable logistic regression models, the sagittal median USL (odds ratio [OR] 1.03) and Lee type C (OR: 7.0) and D (OR: 4.9) were independent predictors for achieving very early continence in the PAD-test.ConclusionPatients’ individual anatomical characteristics in mpMRI prior to radical prostatectomy can be used to predict very early continence. Lee type C and D suggest being the most favorable anatomical characteristics. Moreover, longer sagittal median USL in mpMRI seems to improve very early continence rates.
Highlights
In the treatment of prostate cancer with radical prostatectomy for local tumor control, sufficient postoperative functional outcomes—mainly continence and potency—are of major importance to provide high quality of life in men [1,2,3,4]
We hypothesized that very early postoperative continence rates differ according to the apex shape of the prostate, classified as Lee types A–D, as well as urethral sphincter length after ORP and robotic-assisted radical prostatectomy (RARP)
We hypothesized that very early postoperative continence rates differ according to the apex shape of the prostate, classified as Lee types A–D, as well as the urethral sphincter length in multiparametric magnetic resonance imaging (mpMRI) prior to surgery
Summary
In the treatment of prostate cancer with radical prostatectomy for local tumor control, sufficient postoperative functional outcomes—mainly continence and potency—are of major importance to provide high quality of life in men [1,2,3,4]. Several surgical techniques, such as nerve-sparing procedures or preservation of the “FullFunctional-Length-Urethra” (FFLU) have been investigated with the aim of improving early postoperative continence rates after open (ORP) and robotic-assisted radical prostatectomy (RARP) [5,6,7,8,9]. Multiparametric magnetic resonance imaging (mpMRI) is nowadays frequently employed for prostate cancer diagnostics, staging and surgical planning purposes and individual anatomical characteristics can be visualized and analyzed according to their influence on continence rates after radical prostatectomy [12]. The urethral sphincter length measured in the preoperative mpMRI and the variation of the prostatic apex shape, classified as four types as previously described by Lee et al may yield the potential to predict continence rates [13,14,15,16,17]. To the best of our knowledge the influence of these characteristics on very early continence, defined as urine loss in the validated PAD-test within 24 h after catheter removal, has never been investigated
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